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Alcohol Problems and Treatment -
An Overview
Don Shenker
Chief Executive
Impact of alcohol misuse
W orkplaceAbsentee ism , accidents
and perform ance
F inancia lexpense,
unem ploym ent e tc
Persona l SafetyR isky behaviour and
situation
H ealthphysica l health
and m enta l health
H ousingtenancy problem s,
com pla in ts e tc
C rim eG reater lik lihood of arrest,
drink driv ing anddom estic v io lence
Fam ily and F riendsR elationship problem s,
parenta l negligence,abusive behaviour
Impact of alcohol dependency on health services
• 1 in 4 acute male admissions are alcohol related
• In 11% of cases, alcohol is the main cause of men’s high blood pressure
• Alcohol is a factor in 48% of all violent crime
• At peak times 7 out of 10 people attending A&E have alcohol related problems
• Alcohol misuse costs the NHS £2.7 billion a year and totals £25Bn pa
Daily guidelines for sensible drinking: adults
Recommended ‘sensible drinking’ =• 2-3 units or less for women• 3-4 units or less for men
• CMO recommends no alcohol for under 15s
Department of Health
Units of alcohol
1 unit = half pint beer (3.5% alcohol)
1 unit = single spirits (25ml @ 40% alcohol)
1 unit = 1 glass wine (125 ml @ 8% alcohol)
But these are now quite rare!
Government Categories• Lower risk drinkers (who are at a low risk of alcohol-related illness) are
defined as:• Men who don’t regularly drink more than 3 to 4 units a day• Women who don’t regularly drink more than 2 to 3 units a day
• Increasing risk drinkers (who are at an increasing risk of alcohol-related illness) are defined as:
• Men who regularly drink more than 3 to 4 units a day but less than the higher risk levels
• Women who regularly drink more than 2 to 3 units a day but less than the higher risk levels.
• Higher risk drinkers (who have high risk of alcohol-related illness) are defined as:
• Men who regularly drink more than 8 units a day or more than 50 units of alcohol per week
• Women who regularly drink more than 6 units a day or more than 35 units of alcohol per week
7
Related health conditions
Chronic Disorders• Gastrointestinal• Cardiovascular• Neuropsychiatric
conditions• Cancers• Admissions:34,000
-91,000
Acute Disorders
• Acute Toxic Effects
• Accidents and assaults
• Self-inflicted injuries
• Admissions:40,000-60,000
Sources: DoH (1995), Gutjahr et al (2001), Britton and McPherson (2001)
Alcohol related crime• Estimated 1.2m incidents of alcohol
related violence• 80,000 arrests for drunk and
disorderly• 19,000 sexual assaults related to
alcohol• 85,000 cases of drink driving• 360,000 victims of alcohol related
domestic violence Source: Strategy Unit Interim
Analysis (2003)
Alcohol and the family
• Relationship breakdown
• Domestic violence and aggression
• Health impacts• Poor parenting• Unsafe sex
• Marriages twice as likely to end in divorce
• 1/3 of divorce petitions (W.H.O.)
• About 2m children affected by parental alcohol problem
• Between 30-60% child protection cases
FAST1. MEN: How often do you have EIGHT or more drinks on
one occasion?WOMEN: How often do you have SIX or more drinks on one occasion?
2. How often during the last year have you been unable to remember what happened the night before because you had been drinking?
3. How often during the last year have you failed to do what was normally expected of you because of drinking?
4. In the last year has a relative or friend, or a doctor or other health worker been concerned about your drinking or suggested you cut down?
Cycle of change (Prochaska & DiClemente 1986)
Elements of brief advice:FRAMES
Feedback about risks of substance useResponsibility placed on client to
changeAdvice to cut down / abstain etc.Menu of options and choicesEmpathic approachSelf-efficacy: using a non-
confrontational counselling style which encourages & reinforces client’s strengths
Tier 1Police/CSO
A&E/Walk in Centre/Minor injuriesPrimary Care
Housing
Tier 2Outreach
Drop in services
Assertive Outreach
Specific advice & information services
Tier 3
Tier 4 a&b
Services that work witha wide range of clients
Provide accessiblealcohol specialist services for
a wide range of alcohol misusers
Solely for misusers instructured programmes
of care
Aimed at individuals with a highlevel of presenting need.
Inpatient detox and stabilisation,
residential rehab or residentialcrisis intervention
Self-help groups
Treatment services
Care planned counselling
Stepped Care Approach
Types of treatment
• Advice and information (Tier 2)• Self-help groups (Tier 2)• Care planning counselling (Tier 3)• Structured day programmes (Tier 3)• Community detoxification (Tier 3)• Inpatient treatment (Tier 4)• Residential rehabilitation services (Tier 4)